program development, implementation, and …...assess the implementation of the plan for change...
TRANSCRIPT
Program Development,
Implementation, and
Evaluation
JAN FIELDS
AIR PREP COURSE
MARCH 09, 2017
The problem of chronic illness
Causes 7 in 10 deaths
each year in the United States
133 million American live
with at least one chronic
illness
More than 75% of health
care costs are due to chronic conditions
The problem of chronic illness
The asthma care paradox
Our understanding of the
pathogenesis of asthma
has improved
Our understanding of the
steps to control asthma
has improved
The asthma care paradox
Our understanding of the
pathogenesis of asthma
has improved
Our understanding of the
steps to control asthma
has improved
Morbidity and mortality
from asthma around the
world is still high
The asthma care paradox
Two possible explanations
Not recognizing the symptoms and/or
seriousness of asthma
Two possible explanations
There is a breakdown in
either the delivery or the receiving of therapy
Two possible solutions
Chronic Care Model Patient-Centered
Medical Home
Two possible solutions
Needs Assessment
A Needs assessment
Needs assessment
A Needs assessment
Needs assessment
Needs assessment
Outcome indicators
Prevalence of asthma
Missed work/school days
ED visits
Hospitalizations
Deaths
Health care costs
Lost productivity costs
Needs assessment
The asthma population
Needs assessment
The asthma population
Needs assessment
The asthma population
Needs assessment
The asthma population
Needs assessment
The asthma population
Demographics
Risk stratification Use of controller medications
Use of an asthma action plan
Use of the asthma control test
Number of physician visits per year
Needs assessment
The asthma population
Needs assessment
The asthma population
Needs assessment
The asthma population
Primary care providers
Specialty care providers
Hospitals
Pharmacists Community resources
Case managers
Social workers
Schools/school nurses
Family members
Other ancillary services
Needs assessment
Healthcare Resources
Findings become objectives
Outcomes indicators
become outcomes
objectives
Data about the asthma
population become
learning objectives
Data about the healthcare
community become
resource objectives
Program Development
Program development
Identify resources
Prioritize program features
Compare solutions to needsCreate goals and objectives
Select program activities
Program development
Identify resources—General nonprofit
Program development
Identify resources—General nonprofit
Program development
Identify resources—Funds & Facilities
Program development
Identify resources--Personnel
Program development
Prioritize program features
Using the chronic care model as a blueprint,
evidence-based solutions can be applied at the system level, provider level, and patient level
Program development
Apply solutions to needs
Program development
Apply solutions to needs
Program development
Apply solutions to needs
Program development
Apply solutions to needs
Program development
Create goals and objectives
Program development
Create goals and objectives
• Prevent chronic and troublesome symptoms
• Require infrequent use of inhaled short-acting
beta2-agonist
• Maintain (near) normal pulmonary function
• Maintain normal activity levels • Meet patients’ and families’ satisfaction with asthma
care
Program development
Create goals and objectives
• Prevent recurrent exacerbations of asthma
• Prevent progressive loss of lung function
• Provide optimal pharmacotherapy with minimal or
no adverse effects
Program development
Create goals and objectives
• Private sessions vs. group sessions
• Caregiver education vs. patient education
• Demonstration and return demonstration
• Education materials
Teaching methods include
Program development
Select program activities
Teaching settings include
• clinic/office-based education
• emergency department/hospital-based education
• educational interventions by pharmacists
• educational interventions in school settings
• community-based interventions
• home-based interventions
Program development
Select program activities
Program Implementation
Program implementation
Program implementation
Training program staff—AE-C
Program implementation
Training program staff--CHWs
Program implementation
Maintaining a dashboard
Program implementation
Maintaining a dashboard
Program implementation
Maintaining a dashboard
Program implementation
Maintaining a dashboard
Program implementation
Maintaining a dashboard
Program implementation
Maintaining a dashboard
CDC recommends a yearly
flu vaccine for everyone six
months of age and older
Program implementation
Safety and privacy—Flu shots
Program implementation
Safety and privacy—Flu shots
Program implementation
Safety and privacy—Flu shots
Program implementation
Safety and privacy—Flu shots
Program Evaluation
Program evaluation
Process evaluation vs.
outcome evaluation
Quantitative vs.
Qualitative Methods
Program Evaluation
Process evaluation Outcome evaluation
adherence of participant
to the asthma
management plan
the influence on
participants’ knowledge,
skills, and / or attitudes
procedure and task
implementation by the
asthma team
Program evaluation
Processes
• quality-of-life
• functional status
• asthma control
• healthcare utilization
• participant satisfaction
Program evaluation
Outcomes
Program evaluation
Select validated tools
Juniper QOL surveys
St. George Respiratory
Questionnaire
Spirometry, pulmonary
mechanics, work days or
school days missed
Observations: Observer’s role,
protocol, taking notes, observer
comments, field notes, observer
skills
Interviews: Structured, semi-
structured, unstructured, focus
groups
Program evaluation
Modifying the program
Establishing/re-establishing the aim
Determining who will do what, when, where, and why
A needs assessment might be needed to re-establish the aim
Program evaluation
Modifying the program
Involves executing the plan for change
Assess the implementation of the plan for change
Program evaluation
Modifying the program
This the analysis part of the cycle
Are observed outcomes congruent with desired outcomes
A process and/or outcome evaluation can be used here
Program evaluation
Modifying the program
The CQI team determines what needs to be changed
The cycle is then repeated over and over
Program evaluation
Modifying the program
Program Development,
Implementation, and
Evaluation
JAN FIELDS
AIR PREP COURSE
MARCH 09, 2017